Mupirocin (Centany, Bactroban) is used as a topical antibiotic for superficial skin infections such as impetigo and for the eradication of MRSA carrier state.

Mupirocin Uses:

• Topical infection:

  • Intranasal:
    • It is recommended for use in adults over 12 and healthcare professionals to eradicate nasal colonization of methicillin-resistant S. aureus (MRSA) and lower the risk of infection (as part of a comprehensive infection control program).
    • During institutional outbreaks of MRSA infections, it is recommended nasal decolonization among patients at high risk of infection.

  • Limitations of use:

    • It is not indicated for the prevention of autoinfection (from their own S. aureus nasal colonization) of individuals at high risk or as prophylaxis in other situations.

• Topical cream:

  • The topical cream is recommended for the treatment of secondary infections caused by susceptible isolates of Staphylococcus aureus and Staphylococcus pyogenes.
  • For larger sections that are longer than 10 cm or greater than 100 cm2, it is not advised.

• Topical ointment:

  • Staph aureus and Staph pyogenes-related impetigo are treated with topical ointment.

• Off Label Use of Mupirocin in Adults:

  • For surgical prophylaxis in methicillin-resistant S. aureus (MRSA) carriers, intranasal administration is employed.

Mupirocin dose in adults:

Mupirocin Dose in the treatment of Impetigo:

• Topical Ointment:

  • Apply the cream three times per day to the afflicted region.
  • If there is no clinical response after 3 to 5 days, reassess the patient.

Mupirocin Dose in the treatment of Secondary skin infections:

• Topical Cream:

  • Apply the cream three times per day to the afflicted region.
  • If there is no clinical response after 3 to 5 days, reassess the patient.

Intranasal Mupirocin dose to eliminate MRSA colonization:

• For five days, one nostril receives one-half of the ointment from a single-use tube, and the other nose receives the other half.
• Two times every day, one single-use tube is utilized (two single-use tubes per day).

Intranasal Mupirocin dose in the Surgical prophylaxis in methicillin-resistant S. aureus (MRSA) carriers (off-label):

• One single-use tube is applied twice daily (two single-use tubes per day).
• For five days, apply one nostril with half of the ointment from a single-use tube and the other nostril with the other half.

Mupirocin for the prevention of infections at the exit point or tunnel of peritoneal dialysis catheters (off-label use):

• Topical Cream:

  • Apply once a day to the catheter exit-site to prevent infection
  • Note:  Preferably use the Cream as mupirocin ointment may damage the catheter.

Mupirocin dose in children:

Mupirocin (Intranasal ointment) dose for the decolonization of MRSA:

• Infants and Children:

  • For five to ten days, use a small dose two times per day.

• Children aged 12 years or above and Adolescents:

  • For five to ten days, apply 500 mg (half of the unit-dose tube) twice daily.

Mupirocin dose in the treatment of MRSA or impetigo, minor skin infection, or a limited number of infected lesions:

• Topical: Cream, Ointment:
  • For five to ten days, apply a tiny amount three times every day.
  • Patients should be reevaluated if they show no clinical response after 5 days.

Pregnancy Risk Category: B

• After topical application, it is only minimally absorbed.

Use of topical Mupirocin during breastfeeding

• It is unknown whether the drug will be excreted into breast milk. The drug is not absorbed into breast milk through topical application. Therefore, it is unlikely that the infant will be exposed to it.
• It can be used to treat superficial skin infections in breastfeeding mothers. It can also be used after breastfeeding.
• It should not be used to treat skin infections caused by bacteria or septicemia.
• Apply to the breasts or nipples of breastfeeding mothers.
• If you decide to give it to your baby, consider the risks and benefits.

Dose in Kidney Disease:

The manufacturer has not recommended any adjustments in the dose in patients with kidney disease (it has not been studied).

Dose in Liver disease:

The manufacturer has not recommended any adjustment in the dose (it has not been studied in liver disease).

Side Effects of Topical Mupirocin (Centany):

• Gastrointestinal:

  • Nausea
  • Dysgeusia

• Dermatologic:

  • Pruritus
  • Skin Rash

• Respiratory:

  • Rhinitis
  • Respiratory Congestion
  • Pharyngitis
  • Cough

• Local:

  • Local Pain

Contraindications to Topical Mupirocin (Centany):

Allergy to mupirocin and any component of the formulation

Warnings and precautions

• Hypersensitivity

  • Systemic allergic reactions may occur, such as urticaria, skin rash, angioedema, and anaphylaxis. If a systemic reaction occurs, treatment must be stopped immediately.

• Renal impairment

  • Patients with renal impairment should be cautious as this has not been tested in patients with kidney disease.

• Irritation

  • If there is any irritation or sensitization, the treatment may be stopped.

• Superinfection

  • Long-term antibiotic use can lead to superinfections, including fungal and resistant bacterial infections.
  • It is possible to develop pseudomembranous colitis and CDAD (clostridium-associated diarrhea). Up to two months have reportedly passed after the usage of antibiotics before it happened.

How to administer Mupirocin (Centany)?

Intranasal ointment:

• It is intended for nasal use only. Administration into or near the eyes should be avoided.
• Rinse the eyes with lots of water if you accidentally get something in them.
• The tubes are formulated for single use.
• The drug is administered into the nostrils (emptying the whole tube).
• To uniformly distribute the ointment, gently massage the sides of the nose for a minute after application.
• Discard the tube after use (do not reuse).
• Avoid administering the drug with other drugs simultaneously. Both before and after applying the application, wash your hands.

Topical cream and ointment:

• Using a gauze pad or a cotton swab, Apply a little bit to the affected region. If needed, cover the area with a gauze dressing. Wash hands before and after its use.
• It is intended for external use only. Application into the eyes and on mucous membranes should be avoided. Systemic absorption and dryness of the mucous membranes may occur. In case of contact with the eyes, rinse thoroughly with water.

Mechanism of action of Mupirocin (Centany):

By tying up with bacterial isoleucyl-RNA synthetase, it prevents protein production.

The topical cream or ointment is absorbed:

• It penetrates the skin's outer layers with minimal systemic absorption through intact skin.
• Intranasally administered drugs may cause significant absorption in neonates and preterm infants. Only 3% of the drug is absorbed by adults.

Excretion:

• Urine (as inactive monic acid)

Protein binding:

• Greater than 97%

Half-life elimination:

• 7 to 36 minutes

Metabolism:

• It breaks down quickly into inert monic acid.

International Brands of Mupirocin:

• Bactroban Nasal
• Bactroban
• Centany
• Centany AT
• Bacidal
• Bacron
• Bactafect
• Bactermin
• Bacterocin
• Bactex
• Bactocin
• Bactoderm
• Bactokil
• Bactokill
• Bactreat
• Bactrobaan
• Bactroban
• Bactroban Nasal Ointment
• Bactrocin
• Banbact
• Bantix
• Betrion
• Dermasafe
• Dermatech Bantix
• Dermocin
• Dermucor S
• Esroban
• Foskina
• Macroban
• Mertus
• Mupiban
• Mupicin
• Mupicor
• Mupider
• Mupiderm
• Mupiral
• Mupirax
• Mupiroban
• MupiroNasal
• Mupirox
• Mupirox Nasal
• Muporin
• Muprin
• Muropa
• Murozin
• Pibaksin
• Plasimmine
• Sinpebac
• Skinroban
• Spectroderm
• Supirocin
• Systop
• Tapocin
• Turixin
• Vidox

Mupirocin Brand Names in Pakistan: